The Clinical Profile of Sumatriptan: Cluster Headache

Goadsby, Peter J.

doi:10.1159/000119530

Cited by 22 publications

(3 citation statements)

References 6 publications

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“…Two publications describing three trials were excluded (Goadsby 1994; Hardebo 1998). Details are provided in the Characteristics of excluded studies table.…”

Section: Resultsmentioning

confidence: 99%

Triptans for acute cluster headache

Law

Derry

Moore

2010

Cochrane Database of Systematic Reviews

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Background Cluster headache is an uncommon, but severely painful and disabling condition, with rapid onset. Validated treatment options are limited, and first-line therapy includes inhaled oxygen. Alternative therapies such as intranasal lignocaine and ergotamine are not as commonly used and are less well studied. Triptans are successfully used to treat migraine attacks and, because of this, they may also be useful for cluster headache. Objectives To determine the efficacy and tolerability of triptans for the acute treatment of cluster headaches. Search methods We searched Cochrane CENTRAL, MEDLINE and EMBASE for studies through 22 January 2010. Selection criteria Randomised, double-blind, placebo-controlled studies of triptans for acute treatment of cluster headache episodes. Data collection and analysis Two review authors independently assessed study quality and extracted data. Numbers of participants with different levels of pain relief, requiring rescue medication and experiencing adverse events and headache-associated symptoms in treatment and control groups were used to calculate relative risk and numbers needed to treat (NNT) and harm (NNH). Main results All six included studies used a single dose of triptan to treat an attack of moderate to severe pain intensity. In total 231 participants received zolmitriptan 5 mg, 223 received zolmitriptan 10 mg, 131 received sumatriptan 6 mg, 88 received sumatriptan 12 mg, and 326 received placebo. Zolmitriptan was administered either orally or intranasally, and sumatriptan either subcutaneously or intranasally. Overall, the triptans studied were better than placebo for headache relief and pain-free responses, with an NNT of 2.4 for 15 minute pain relief with subcutaneous sumatriptan 6 mg (75% with sumatriptan and 32% with placebo), and 2.8 for 30 minute pain relief with intranasal zolmitriptan 10 mg (62% with zolmitriptan and 26% with placebo). Fewer participants need rescue medication with triptan than with placebo, but more experienced adverse events. Authors’ conclusions Zolmitriptan and sumatriptan are effective in the acute treatment of cluster headaches and may provide a useful treatment option, potentially offering convenience over oxygen therapy and a better safety and tolerability profile than ergotamine. Non-oral routes of administration are likely to provide better and more rapid responses.

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“…Two publications describing three trials were excluded (Goadsby 1994; Hardebo 1998). Details are provided in the Characteristics of excluded studies table.…”

Section: Resultsmentioning

confidence: 99%

Triptans for acute cluster headache

Law

Derry

Moore

2010

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

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“…Two publications describing three trials were excluded (Goadsby 1994;Hardebo 1998). Details are provided in the 'Characteristics of excluded studies' table.…”

Section: Excluded Studiesmentioning

confidence: 99%

“…Reason for exclusion Goadsby 1994 Not original research. Uses in its analysis the data from Ekbom 1991 andEkbom 1993 Hardebo 1998 Open study, not double-blinded…”

Section: Studymentioning

confidence: 99%

Triptans for acute cluster headache

Law

Derry

Moore

2013

Cochrane Database of Systematic Reviews

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Effectiveness of Intranasal Zolmitriptan in Acute Cluster Headache

Cittadini¹,

May²,

Straube³

et al. 2006

Arch Neurol

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129

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Background: Cluster headache is a form of primary headache in which attacks are rapid in onset with very severe pain. The mainstays of acute therapy are inhaled oxygen and sumatriptan succinate injection. Objective: To evaluate zolmitriptan nasal spray in the acute treatment of cluster headache. Methods: Ninety-two patients, aged 40 ± 10 years (mean ± SD) (80 men and 12 women), with International Headache Society-defined cluster headache were randomized into a placebo-controlled, double-blind crossover study. Patients treated 3 headache attacks using placebo for 1 attack, 5 mg of zolmitriptan nasal spray (ZNS5) for 1 attack, and 10 mg of zolmitriptan nasal spray for 1 attack. The primary end point was headache relief at 30 minutes, defined as reduction from moderate, severe, or very severe pain to no or mild pain. The study was approved by the appropriate ethics committees. Results: Sixty-nine patients were available for an intentionto-treat analysis. The 30-minute headache relief rates were placebo, 21%; ZNS5, 40%; and ZNS10, 62%. Modeling the response as a binary outcome, the Wald test was significant for the overall regression (2 1 =29.4; PϽ.001), with both ZNS5 and ZNS10 giving significant effects against placebo. Headache relief rates for patients with episodic cluster headache were 30% for placebo, 47% for ZNS5, and 80% for ZNS10, while corresponding rates for patients with chronic cluster headache were 14%, 28%, and 36%, respectively. Zolmitriptan was also well tolerated. Conclusion: Five-milligram and 10-mg doses of zolmitriptan intranasal spray are effective within 30 minutes and well tolerated in the treatment of acute cluster headache.

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The Clinical Profile of Sumatriptan: Cluster Headache

Cited by 22 publications

References 6 publications

Triptans for acute cluster headache

Triptans for acute cluster headache

Triptans for acute cluster headache

Effectiveness of Intranasal Zolmitriptan in Acute Cluster Headache

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